Outcomes of a Contemporary Amputation Series

Lim, Tao Shan; Finlayson, Andrew; Thorpe, James M.; Sieunarine, Kishore; Mwipatayi, Bibombe P.; Brady, A.J.B.; Abbas, Manzoor; Angel, Donna

doi:10.1111/j.1445-2197.2006.03715.x

Cited by 93 publications

(146 citation statements)

References 19 publications

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“…LLA is often performed as a life-saving measure for a critically ischemic or infected limb in patients with DM or PVD. 1,26) These critically ill patients may not survive the perioperative period. Additionally, unresolved underlying diseases may disturb wound healing and cause recurrent infections.…”

Section: Discussionmentioning

confidence: 99%

“…In recent studies, PVD and DM accounted for 61.0%-92.5% of LLAs. [1][2][3][4] Previous studies have also reported high postoperative mortality rates ranging from 4.2% to 13.5% among patients undergoing LLA. 2,3,[5][6][7][8][9][10][11][12] Reported risk factors for death after LLA include age; male sex; the site of amputation; the requirement of dialysis; and a diagnosis of PVD, DM, coronary artery disease, myocardial infarction, or renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

“…From the 1970s to the 1990s, the main reason for LLA was traumatic injury. [1][2][3] However, peripheral vascular disease (PVD) and diabetes mellitus (DM) have emerged as major causes of LLA. In recent studies, PVD and DM accounted for 61.0%-92.5% of LLAs.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Endoh

Yamana

Nakahara

et al. 2017

PRM

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Objective: Studies on the outcomes of lower limb amputation have been limited by the use of selected study populations and small sample sizes. Although reamputation is an important outcome following lower limb amputation, the risk factors for reamputation remain to be elucidated. The present study was performed to identify risk factors for in-hospital death and reamputation following lower limb amputation. Methods: Using a national inpatient database in Japan, we identified 13,774 patients who underwent lower limb amputation. We examined the patients' backgrounds and employed a multivariable logistic regression analysis to identify factors associated with in-hospital death or reamputation. Results: The average age of the 13,774 patients was 72.4 years, and 63.1% (n=8694) were male. The overall in-hospital mortality rate was 10.8% (1481/13,774). The reamputation rate was 10.1% (782/7779) for patients who initially underwent foot or transtibial amputation (18.2% [391/2148] for foot amputations and 6.9% [391/5631] for transtibial amputations). Multivariable logistic regression analysis revealed higher age, male sex, peripheral vascular disease, use of insulin, hemodialysis, and higher numbers of comorbidities as significant risk factors for reamputation or in-hospital death. Use of hemodialysis was the strongest risk factor (odds ratio, 2.10; 95% confidence interval, 1.87-2.35). Conclusions: The in-hospital mortality and reamputation rates following lower limb amputation were considerably high, reflecting the severely ill conditions of patients with advanced chronic diseases. Risk factors for in-hospital death and reamputation following lower limb amputation were identified. These should aid surgeons in determining a patient's risk of a poor outcome and deciding on the level of amputation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Endoh

Yamana

Nakahara

et al. 2017

PRM

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“…It was not possible to determine the reasons for death in our database, but previous studies have reported a 6%-10% 30-day mortality in this patient population. [19][20][21] Mortality among lower-extremity amputees has been shown to increase with the degree of renal dysfunction and is greatest in dialysis-dependent patients, who have a reported 30-day mortality of 16%. 22 Patients with diabetes have also been shown to have twice the risk of postoperative mortality after lower-extremity amputation compared with nondiabetic patients.…”

Section: Mortalitymentioning

confidence: 99%

A Canadian population-based description of the indications for lower-extremity amputations and outcomes

Kayssi¹,

Mestral²,

Forbes³

et al. 2016

cjs

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Background: To our knowledge, there have been no previously published reports characterizing lower-extremity amputations in Canada. The objective of this study was to describe the indications and outcomes of lower-extremity amputations in the Canadian population. Methods:We performed a retrospective cohort study of all adult patients who underwent lower-extremity amputation in Canada between 2006 and 2009. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada with the exception of the province of Quebec. Pediatric, trauma, and outpatients were excluded.Results: During the study period, 5342 patients underwent lower-extremity amputations in 207 Canadian hospitals. The mean age was 67 ± 13 years, and 68% were men. Amputations were most frequently indicated after admission for diabetic complications (81%), cardiovascular disease (6%), or cancer (3%). In total, 65% of patients were discharged to another inpatient or long-term care facility, and 26% were discharged home with or without extra support. Most patients were diabetic (96%) and most (65%) required a below-knee amputation. Predictors of prolonged (> 7 d) hospital stay included amputation performed by a general surgeon; cardiovascular risk factors, such as diabetes, hypertension, ischemic heart disease, congestive heart failure, or hyperlipidemia; and undergoing the amputation in the provinces of Newfoundland and Labrador, New Brunswick, or British Columbia. Conclusion:There is variability in the delivery of lower-extremity amputations and postoperative hospital discharges among surgical specialists and regions across Canada. Future work is needed to investigate the reasons for this variability and to develop initiatives to shorten postoperative hospital stays.Contexte : À notre connaissance, aucun rapport caractérisant les amputations des membres inférieurs n'a été publié au Canada à ce jour. L'objectif de la présente étude était de décrire les indications et les résultats de ces amputations dans la population canadienne. Résultats : Durant la période à l'étude, 5342 patients ont subi l'amputation d'un membre inférieur dans 207 hôpitaux canadiens. L'âge moyen était de 67 ± 13 ans, et 68 % des patients étaient des hommes. Les amputations étaient principalement recommandées après l'hospitalisation pour des complications du diabète (81 %), une maladie cardiovasculaire (6 %) ou un cancer (3 %). Au total, 65 % des patients ont été transférés vers un autre établissement hospitalier ou de soins de longue durée après leur congé, et 26 % sont retournés à la maison avec ou sans soutien supplémentaire. La plupart des patients étaient diabétiques (96 %), et la plupart (65 %) ont subi une amputation sous le genou. Les indicateurs d'hospitalisation longue (> 7 jours) comprenaient l'amputation par un chirurgien généraliste; les facteurs de risque cardiovasculaires, comme le diabète, l'hypertension, la cardiopathie ischémique, l'insuffisance cardiaque congestive ou l'hy...

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“…2 Outcome in rehabilitation is also influenced by psychological and cognitive wellbeing of an individual, social support, economic status and multiple prosthesis related factors. 3,4 After lower limb amputation, the main aim of the rehabilitation team is to restore mobility and optimum physical functioning of an individual.…”

Section: Introductionmentioning

confidence: 99%

Correlation of ambulation potential with quality of life in lower limb amputees

Agrawal

Kalra

Joshi

2017

Int J Community Med Public Health

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Background: To identify the effect of walking ability on quality of life in lower limb amputees and draw a correlation between prosthesis use, socio economic status and quality of life. It was an Observational Cross sectional study.Methods: Lower limb amputees excluding hip disarticulation and bilateral lower limb amputation, individuals above eighteen years of age who attended rehabilitation research centre outpatient door were interviewed. Structured questionnaire including patient background, amputation characteristics and details regarding prosthesis, was administered along with detailed musculoskeletal examination. Outcome variables: Locomotor capability index (LCI) and timed up and go test (TUG) were used for ambulation potential and Short form 36 (SF 36) for quality of life.Results: Significant correlation was observed between mental health short form 36 score and locomotor capability index (basic and advanced). Poor negative correlation of SF 36 score was observed with age (r=-0.125, p=0.006S). Significant correlation was observed between Physical Health Short Form 36 score and locomotor capability index (basic and advanced), and this correlation was higher and more significant. Poor negative correlation of SF 36 score was observed with age (r=-0.203, p<0.001S).Conclusions: Ability to ambulate is an independent factor that has a positive correlation with quality of life.

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Outcomes of a Contemporary Amputation Series

Cited by 93 publications

References 19 publications

Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

Risk Factors for In-hospital Mortality and Reamputation Following Lower Limb Amputation

A Canadian population-based description of the indications for lower-extremity amputations and outcomes

Correlation of ambulation potential with quality of life in lower limb amputees

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